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Table of Contents

Article

Each year in the United States, approximately 30,000 persons
with BB and pellet gun * -related injuries are treated in
hospital emergency departments (EDs) (1). Most (95%) injuries are
BB or pellet gunshot wounds (GSWs); 5% are other types of
injuries (e.g., lacerations sustained inadvertently while
cleaning or shooting a gun or contusions resulting from being
struck with the butt of a gun) (1). Most (81%) persons treated
for BB and pellet GSWs are children and teenagers (aged less than
or equal to 19 years). To assist in developing strategies for
preventing these injuries, CDC analyzed data from an ongoing
special study of nonfatal gun-related injuries conducted using
the National Electronic Injury Surveillance System (NEISS) of the
U.S. Consumer Product Safety Commission; this study has
characterized the epidemiology of BB and pellet GSWs among
children and teenagers in the United States during June 1992-May
1994 (2). This report summarizes the circumstances of six cases
of BB and pellet gun-related injuries identified through NEISS
and presents the findings of the analysis of NEISS data.
NEISS includes a probability sample of 91 hospitals selected
from all hospitals with at least six beds and that provide
24-hour emergency service (2). Data were weighted to provide
national estimates of injuries treated in hospital EDs in the
United States and its territories (1).

Case Reports

A 9-year-old boy was struck by a BB beneath his lower left
eyelid after he stepped from behind a board at which other
children were shooting. The children had been left
unsupervised following a youth club target practice session.

A 16-year-old boy sustained a severe midbrain injury from a
self-inflicted combination BB/pellet gun GSW through the
roof of his mouth.

A 9-year-old girl incurred a pellet injury to the back of
her right ankle after four boys fired a pellet gun at her
from a passing car while she was walking on a sidewalk.

A 10-year-old boy sustained injuries to his neck and trachea
after being struck by a BB from a gun that had been fired
unintentionally by an unspecified person.

A 13-year-old boy was shot in the neck with a BB gun while
he and a friend were playing in a house. The friend, who
believed the gun was unloaded, had aimed the gun at the
13-year-old and pulled the trigger.

A 16-year-old boy sustained a penetrating injury to his
right eye after being struck by a BB that ricocheted from a
gun fired by a friend.

Summary of NEISS Data

During June 1992-May 1994, a total of 959 BB and pellet GSWs
among children and teenagers were reported through NEISS. Based
on these reports, an estimated 47,137 (95% confidence interval
{CI}=39,746-54,528) children and teenagers were treated for BB or
pellet GSWs in hospital EDs during this period (an average of
23,600 per year or 65 per day) (Table 1). The incidence of BB
or pellet gun-related injuries was highest for males (53.5 per
100,000 population) and children aged 10-14 years (66.6 per
100,000 population) (Table 1), and the sex- and age
group-specific rate was highest for males aged 10-14 years (114.3
per 100,000 population {95% CI=94.1-134.5}).

Although most (64%) persons with GSWs were transported to
Eds by private vehicles, 8% of those treated were taken to EDs by
emergency medical services (Table 2). Injuries to the eye,
face, and head and neck accounted for 31% of all injuries.
Hospitalization was required for 5% of cases; of these, 37% were
associated with severe injury to the eye.

Data on victim-shooter relationship were complete for 71% of
cases (Table 2). Based on these data, 31% of injuries were
self-inflicted, and 33% were caused by friends, acquaintances, or
relatives. Data on 76% of the incidents indicated the type of
injury: although most (66%) resulted from unintentional
shootings, approximately 10% were assaults; suicide attempts were
rare (0.1%). Locale of the injury incident was known for
approximately 55% of cases; approximately 45% of injuries
occurred in and around a home, apartment, or condominium.

Reported by: Office of Statistics and Programming, Div of
Violence Prevention and Div of Unintentional Injury Prevention,
National Center for Injury Prevention and Control, CDC.

Editorial Note

Editorial Note: An estimated 3.2 million nonpowder guns are sold
in the United States each year; 80% of these have muzzle
velocities greater than 350 feet per second (fps) and 50% have
velocities from 500 fps to 930 fps (AC Homan, US Consumer Product
Safety Commission, unpublished data, 1994). Most of these guns
are intended for use by persons aged 8-18 years. At close range,
projectiles from many BB and pellet guns, especially those with
velocities greater than 350 fps, can cause tissue damage similar
to that inflicted by powder-charged bullets fired from
low-velocity conventional firearms (3). Injuries associated with
use of these guns can result in permanent disability or death
(4); injuries from BBs or pellets projected from air guns
involving the eye particularly are severe (5). For example, based
on data from the National Eye Trauma System and the United States
Eye Injury Registry -- a system of voluntary reporting by
ophthalmologists -- projectiles from air guns account for 63% of
reported perforating eye injuries that occur in recreational
settings (6).

Despite the large number of BB and pellet gun-related
injuries treated in hospital EDs each year (1), there are no
nationally specified safety standards for nonpowder guns.
Although voluntary industry standards were established in 1978
and revised in 1992 (7), the effectiveness of these standards for
preventing injuries has not been determined. These voluntary
standards specify two types of warning labels, including one on
the gun itself ("WARNING: Before using read Owner's Manual
available free from {company name}"), and one on the packaging
("WARNING: Not a toy. Adult supervision required. Misuse or
careless use may cause serious injury or death. May be dangerous
up to {specific distance} ** yards ({specific distance}
meters).") (7). The voluntary standards also specify that the
owner's manual should provide instructions about handling and
operating the gun safely, selecting safe and proper targets,
caring for and maintaining the gun properly, storing of the gun
in an unloaded state and in a safe and proper manner, and always
confirming that the gun is unloaded when removed from storage or
received from another person (7). However, these standards do not
include specifications regarding other important
injury-prevention measures pertinent to minors (e.g., limits on
maximum velocity and impact force of BBs and pellets or design
modifications to clearly indicate when a gun is loaded) (8).
In the United States, 14 states have enacted laws to
regulate the sale or possession of nonpowder guns. Although most
of these states restrict the purchase, possession, or use of
these guns by minors aged less than 16 years or aged less than 18
years, such age restrictions on the purchase of these guns are
void in most of these states when a minor has obtained permission
from a parent or guardian.

Analysis of the NEISS data indicate that BB and pellet GSWs
treated in hospital EDs typically result from an unintentional
shooting of a young or adolescent male who either shot himself or
was shot by a friend, acquaintance, or relative. Many of these
shootings occur when using or playing with a gun in or around the
home. These findings suggest that ready access to a BB or pellet
gun and ammunition stored in the home and/or the lack of
supervision during use of the gun may contribute substantially to
the risk for injury among children and adolescents, especially
for boys aged 10-14 years. Although most BB and pellet gun
injuries are unintentional, the findings from this analysis and
from a statewide ED-based surveillance system in Massachusetts
(9) also indicate that BB and pellet guns sometimes have been
used to purposefully inflict harm.

Unintentional BB and pellet gun-related injuries that occur
during unsupervised activities are preventable. Parents
considering the purchase of a BB or pellet gun for their children
should be aware of the potential hazards of these guns, and
should help to ensure the safety of their children in the
presence of a BB or pellet gun. Children and teenaged users
should recognize that these guns are not toys but are designed
and intended specifically for recreational and competitive sport
use. Parents or other adults should provide direct supervision at
all times for each child who is using or observing the use of
these guns. Each user should be educated about the potential
danger of these guns, the importance of gun-safety practices, and
how to safely handle and fire the gun. The use of protective
eyewear should be enforced during shooting activities. When not
in use, all guns in the home should be kept locked up and
unloaded. Subsequent efforts to reduce the severity and frequency
of injuries associated with BB and pellet guns should include
determination of the effectiveness of a variety of interventions
(e.g., technological, regulatory, environmental, and behavioral).

Committee on Standards, American Society for Testing and
Materials. Standard consumer safety specification for
non-powder guns. Conshohocken, Pennsylvania: American
Society for Testing and Materials, 1992.

* In this report, the terms BB gun and pellet gun refer to
nonpowder guns that use compressed air or gas to propel lead
pellets or steel BBs.

** Distance is dependent on the type of gun and muzzle velocity.

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